Provider Demographics
NPI:1710597976
Name:SOUTHEAST MISSOURI AREA AGENCY ON AGING, INC.
Entity Type:Organization
Organization Name:SOUTHEAST MISSOURI AREA AGENCY ON AGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:VONHASSELN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-335-3331
Mailing Address - Street 1:1078 WOLVERINE LN STE J
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-9021
Mailing Address - Country:US
Mailing Address - Phone:573-335-3331
Mailing Address - Fax:
Practice Address - Street 1:1078 WOLVERINE LN STE J
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-9021
Practice Address - Country:US
Practice Address - Phone:573-335-3331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals